单纯内镜下乳头大球囊扩张术和内镜下乳头球囊扩张术,不行EST,治疗胆管巨大结石:倾向性匹配分析

时间:2019-11-18 作者:翻译:王君俊 审校 点击:332次
单纯内镜下乳头大球囊扩张术和内镜下乳头球囊扩张术,不行EST,治疗胆管巨大结石:倾向性匹配分析
 
 
未行内镜下括约肌切开术(EST)的内镜下乳头大球囊扩张术(EPLBD),可通过充分扩张壶腹部促进胆管巨大结石的取出。然而,与内镜下乳头球囊扩张术(EPBD)后良好的长期预后相反,未行EST的EPLBD的研究很少。因此,我们进行了本研究,以评估未行EST的EPLBD和EPBD在治疗胆管巨大结石(LBDS;≥10 mm)后的短期和长期疗效。这项回顾性研究包括既往无EST、EPBD或EPLBD病史的患者,他们接受了无EST的EPLBD或EPBD来治疗LBDS。未行EST组的EPLBD患者通过倾向性评分与EPBD组的患者相匹配。每组44名患者进行配对分析。倾向性匹配后的基线特征是平衡的。未行EST组的EPLBD患者单次取石率较高(80%vs 16%,p<0.001),ERCP次数(1.3±0.7 vs 2.4±1.5,p<0.001)和碎石使用率(30%vs 80%,p<0.001)均较少。与组间早期不良事件的无差异(p=0.99)相反,未行EST组的EPLBD患者晚期胆道并发症的累积率更高(p=0.02)。未行EST的EPLBD对LBDS的清除率较高,但与EPBD相比,其长期疗效较差。
 
 
Endoscopic papillary large balloon dilation and endoscopic papillary balloon dilation both without sphincterotomy for removal of large bile duct stones: A propensity-matched analysis.
Hakuta RKawahata SKogure H,al.Dig Endosc. 2019 Jan;31(1):59-68 

Endoscopic papillary large balloon dilation (EPLBD) without endoscopic sphincterotomy (EST) may facilitate extraction of large bile duct stones through achieving adequate dilation of the ampulla. However, contrary to favorable long-term outcomes after endoscopic papillary balloon dilation (EPBD), that of EPLBD without EST has been little investigated. Therefore, we conducted the current study to evaluate short- and long-term outcomes of EPLBD without EST and EPBD after removal of large bile duct stones (LBDS; ≥10 mm). This retrospective study included patients without a previous history of EST, EPBD or EPLBD who underwent EPLBD without EST or EPBD for removal of LBDS. Each patient in the EPLBD without EST group was matched to a patient in the EPBD group using propensity scores. Forty-four patients in each group were matched for the analysis. Baseline characteristics were balanced after propensity matching.Rate of complete stone removal in a single session was higher (80% vs 16%, P < 0.001), number of ERCP sessions (1.3 ± 0.7 vs 2.4 ± 1.5, P < 0.001) and rate of lithotripsy use (30% vs 80%, P < 0.001) were smaller in the matched EPLBD without EST group. Contrary to null between-group differences in early adverse events (P = 0.99), a cumulative rate of late biliary complications was higher in the EPLBD without EST group (P = 0.02). EPLBD without EST showed higher efficacy for removal of LBDS but was associated with worse long-term outcomes when compared to EPBD.

翻译:王君俊    审校:张立超、侯森林
Ryunosuke H , Shuhei K , Hirofumi K , et al. Endoscopic papillary large balloon dilation and endoscopic papillary balloon dilation both without sphincterotomy for removal of large bile duct stones: a propensity-matched analysis[J]. Digestive Endoscopy, 2018.